Studies reveal drop in PCa treatment, rise in metastatic disease

Findings from two new studies provide insight on how changing recommendations for prostate cancer screening and management have impacted practice patterns.

In what they believe to be the first population-level analysis of treatment rates during the period after the U.S. Preventive Services Task Force (USPSTF) issued recommendations discouraging PSA screening, Tudor Borza, MD, MS, and colleagues conducted a retrospective cohort study using Medicare data (Health Aff [Millwood] 2017; 36:108-15). Their review included 67,023 Medicare beneficiaries aged 66 years and older who were newly diagnosed with prostate cancer in 2007 to 2012.

They analyzed population-based treatment rates as a measure of trends in diagnosis and treatment patterns along with treatment rates among diagnosed men, which would be sensitive only to changes in treatment patterns. A third analysis investigated trends in treatment for the subgroup of men with a high risk of non-cancer mortality within 10 years of diagnosis.

The authors found the population-based treatment rate fell by 42% between 2007 and 2012 (from 4.3 to 2.5 per thousand Medicare beneficiaries) while there was only an 8% drop (from 718 to 659 per thousand Medicare beneficiaries) among diagnosed men.

“The difference between these two rates indicates that decreased screening for prostate cancer led to substantially fewer men being diagnosed and therefore eligible for treatment,” said Dr. Borza, of the University of Michigan, Ann Arbor.

“However, the modest decrease in treatment rate among diagnosed men indicates that use of surveillance strategies has only slightly increased. In our population, nearly three-fourths of men diagnosed with prostate cancer received initial curative treatment as opposed to active surveillance or watchful waiting,” added Dr. Borza, who worked on the study with Brent K. Hollenbeck, MD, MS, and colleagues.

There was no change in treatment rates for men with ≤10-year life expectancy related to comorbidities.

“These findings show that the adoption of less intense screening practices outpaced the adoption of surveillance strategies. Once a diagnosis of prostate cancer is established, it appears that patients and physicians are still cautious about choosing surveillance as the initial treatment. We need better tools to identify which men should be screened and, among those diagnosed, which men should be treated aggressively. It’s that uncertainty that leads to different approaches to treatment based on how different patients and physicians view the risk. If we get better at predicting who is at highest risk, we can more accurately tailor screening and treatment,” Dr. Borza said.